Pain Relief For Arthritis Happy Valley, OR

Fix Your Sit Part I

1Fix Your Sit Fix Your Sit Part IThe Least You Need To Know:

  1. Most of us either sit for work, sit to get to work or spend a significant amount of time sitting for our recreational activities (TV, movies, computers, and biking- Yes, biking is sitting, just a different kind of sitting).
  2. There is nothing inherently bad about sitting, but the volumes we tend to do are typically not good for us. The postures used for sitting have some adverse effects our body, not only while we sit but after we stand up and walk around.
  3. Controlling how much harm our sitting does is best managed by improving hip mobility, thoracic extension, and learning to use abdominal muscles to brace our low back.
  4. Basic exercises pre and post sitting can help us tolerate the monumental task of sitting without it feeling like we have spent all day digging post holes in the desert.

After the post about making exercise a part of your life and how work plays a part in how much time you have to exercise we got a lot of questions about how to combat the problems associated with sitting. Here is one of them,

“I just feel hopeless with this issue. I sit all day long. While I ride my bike to and from work and try to work out in the gym, I’ve read that it doesn’t really make a difference — that sitting is just killing us slowly. If sitting is the new smoking, can you imagine the lawsuits?” – Louis

Yes, it appears that sitting is slowly killing us (or at least causing us significant low back pain), but that’s because we do a disproportionate amount of it in comparison to postures and activities that help reinforce good back mechanics. If you spent 90% of your waking hours standing, walking, and other non-sitting activities sitting would not only be a welcomed relief but would help resolve pain that is more associated with standing for long periods of time. However, sitting too little doesn’t seem to be our (society’s) problem. Some of the problems we see when people sit a lot is slouching: postural flexion of the lumbar curve, the pelvis tips back, the thoracic spine (ribs) round forward, and the tissues on the front of the hip become stiff and short. Since sitting is likely not going away, it’s worth knowing how to do it well.

Posture:

Pelvic Posture

This is arguably the single most important aspect of sitting well because it is a bony connection to the spine. Because of this, the lumbar spine will always follow the position of the pelvis. Go ahead and try to move your pelvis independently of your low back. It just doesn’t happen. It’s a little hard to see and feel the motion of the pelvis because there are a lot of muscles attached to it, but we are going to try. If you place the web space of your hand (between your thumb and index finger) so that it wraps around the highest part of your pelvis on the side of your body, your index fingers tend to point straight forward to very slightly downward when your pelvis is in neutral (see photo). If you feel like you have to try to rip your own thumbs off to perform this test then your are likely too far tipped back. This is by far the most common problem we see at the pelvis in sitting.

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fingers pointing slightly down is a good first indicator that you are not rolling your pelvis back, which flattens your low back and stretches the muscles most commonly associated with low back pain

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not that the fingers are fairly flat (to the ground) and that the spine above also tends to move into a poor posture, head moves out forward from the body, rib cage drops forward, generally less handsome.

Cervical Posture

While cervical posture is highly important to healthy sitting we are going to leave it for another day. You can get a peak of what we are talking about in the pictures, with the ear coming past the shoulder and the upper cervical curve becoming more sharp as it attaches to the base of the skull. Email us with questions and that blog post will appear sooner.

Testing:

So, how are you doing? Know what we are supposed to do and finding out if we are actually doing it is easier said than done. Here are some ideas for self-assessing how you are doing.

The Stick Test

I like a test that shows how the spine and pelvis are doing together. For lack of a better name I know it as “the stick test.” Grab a dowel (yard stick, pool cue, or broom handle) and hold it behind your back with your palm facing out and your knuckles resting over your lumbar spine (low back). The bottom of the stick should rest right over your tail bone, and top of the stick should rest in the middle of your shoulder blades. Bonus points for the stick also lightly resting on the back of your head when you are looking straight ahead (cervical spine will be the subject of a later post). Here are some pictures of the stick test with interpretations of posture:

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Neutral standing posture

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Increased thoracic flexion or “kyphosis”

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Increased thoracic flexion with posterior pelvic tilt causing a flexed low back,loss of “lordosis”

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Neutral seated posture

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Thoracic flexion

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Thoracic flexion with forward cervical posture

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Thoracic flexion, forward cervical posture and posterior pelvic tilt

Some things to consider:

  1. Does the stick rest comfortably at these landmarks?
  2. Does holding the stick at your low back mean it only contacts at the shoulder blades or pelvis? Or neither?
  3. Does the stick hit you in the back of the head? Did you move it to the side of your head to get it to land between your shoulder blades?
  4. Can you make it reach these landmarks by moving your body?
  5. What parts of this test feel the most difficult? Does it feel like you have to reach your shoulders back or stick your butt out?
  6. Can you do this sitting on a flat surface like a dining room chair without using the chair back or do you rely on a chair to push you into a position that resembles neutral?
  7. Compare the results sitting and standing, are they the same?

How do you fix back pain from sitting? Fix how you use your back. Why should the fact that you sat down change the shape of your spine? If your hips force you into a bad position, fix the hips. If you can’t hold yourself up, get stronger. If you can’t get your spine to move into neutral or it’s just a lot of work, you need to improve mobility of the spine and the muscles around it. If this seems difficult or confusing let a Physical Therapist help you regain that motion.

Next time we will pick it up with how to interpret the test, and most importantly what to do about it. Can’t wait? Anticipation and your back just killing you? Come visit us in Happy Valley, OR. Physical Therapy really should be your first stop for chronic back pain. You should have a plan after a single visit with Physical Therapy to change how you move and improve your pain.

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